Quality of Life in Patients with Acromegaly – a Romanian Single Center Cross-Sectional Study

Reti

et al. 2022

J Patient Rep Outcomes

Introduction Acromegaly is a rare chronic endocrine disorder that can lead to significant quality of life (QoL) impairment and persistent symptomatology in both biochemically uncontrolled as well as in cured or controlled patients. We aimed to conduct an observational cross-sectional study investigating the associations between biochemical disease control, associated comorbidities, and symptoms severity on QoL in a cohort of acromegalic patients. Methods Thirty-one patients with acromegaly were enrolled in our study. AcroQoL and PASQ (Pain assessed acromegaly symptoms questionnaire) questionnaires were applied to all patients. Information about disease status, associated comorbidities, and other relevant clinical and paraclinical data were gathered. Results Patients with uncontrolled acromegaly presented worse QoL and symptoms scores than controlled patients, but the difference was not statistically significant (AcroQoL 57.22 vs 64.04, p > 0.05; PASQ 12 vs 16.47, p > 0.05). Worse symptoms were significantly associated with impaired QoL (overall symptoms score on PASQ was negatively correlated with AcroQoL total score, r = − 0.61, p < 0.05). Cardiovascular complications were associated with lower QoL scores, but not with worse symptoms (AcroQoL total score in patients with- versus patients without cardiovascular complications: 54.89 vs 70.14, p < 0.05). Conclusions Achieving biochemical control of acromegaly might not be enough to reverse the QoL impairment and improve symptomatology in acromegalic patients. While symptoms severity and the presence of cardiovascular complications seem to play an important role in reducing patients QoL, the roles of disease control, diabetes, and pituitary insufficiency are less clear.

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Associations between paraclinical parameters, symptoms and quality of life in patients with acromegaly: a cross sectional study

Reti

et al. 2022

J Patient Rep Outcomes

“…However, confirmed in most studies, the long evolution until diagnosis explains the high prevalence of acromegaly complications. The highest impact upon survival is related to cardiovascular complications, while the quality of life is impacted mostly due to chronic degenerative osteoarticular changes ( 2 ).…”

mentioning

confidence: 99%

Editorial: Insights Into Acromegaly Complications

Badiu

Witek

2022

Front. Endocrinol.

Editorial on the Research Topic Insight into Acromegaly ComplicationsAcromegaly is a rare endocrine multisystemic disorder, caused in the vast majority of cases by a somatotroph pituitary adenoma. The excess secretion of growth hormone (GH) and consequently, of insulin like growth factor 1 (IGF1) cause many physio-pathological changes in virtually all organs and tissues (osteoarticular system, muscles, brain, heart and blood vessels, respiratory and hematopoietic system, kidneys, liver and pancreas, thyroid, adipose tissue). In addition, several important complications might appear due to adenoma compression on neighboring neural anatomic structures, upon optic pathway or oculomotor nerves from the cavernous sinuses. Compression upon the normal pituitary tissue could lead to associated pituitary insufficiency. Excess of GH and IGF-1 trigger well documented colonic and thyroid neoplastic changes. All these are considered acromegaly complications and deserve a detailed, personalized approach.Epidemiological data shows that acromegaly is diagnosed with an incidence of 3.8 cases per million, with a prevalence of 6 per 100.000 (1). However, confirmed in most studies, the long evolution until diagnosis explains the high prevalence of acromegaly complications. The highest impact upon survival is related to cardiovascular complications, while the quality of life is impacted mostly due to chronic degenerative osteoarticular changes (2).Currently, the selective transsphenoidal adenomectomy is the first line treatment, followed by medical therapy using somatostatin receptor ligands (SRLs) (3), dopamine agonists or GH receptor blocker pegvisomant. Radiotherapy is used in selected cases, especially in resistant, invasive adenomas. Presurgical treatment with SRLs could be used in selected cases, for a better hormonal and/or tumour control, especially for those with severe cardiovascular involvement and high surgical risk (4).Current Research Topic remains of high scientific and clinical interest, and includes five papers from well known pituitary research groups from Poland and Brasil.

Growth Hormone Excess: Implications and Management

Dhaneshwar

Shandily

Vatsalya

2023

EMIDDT

Acromegaly is described by oversecretion of growth hormone (GH) and, subsequently, insulin-like growth factor 1 (IGF-1), ascribed in most cases to a pituitary adenoma. This disease presents a progressive disfigurement, along with other systemic manifestations, which altogether diminishes the quality of life in the patients. Prolonged exposure to abnormally high levels of GH and IGF-1 levels results in cardiovascular, cerebrovascular, and pulmonary dysfunction which overall produces a fall in life expectancy. Timely diagnosis and treatment further, decreased the mortality rate of the patients and showed an improvement in the quality of life. Surgical procedures, advanced radiation therapy tools, and the availability of pharmacological compounds that act on pituitary growth hormone-producing cells have enabled an improved approach to the treatment of the disease. Pharmacological treatment is currently an important management option, and it may also be the first-line treatment in patients with acromegaly who do not benefit from or are ineligible for first-line surgical procedures. From its inception until 2021, we used a comprehensive search strategy on Medline/PubMed, Scopus, Embase, Web of Science, and the Cochrane Library electronic databases. All human research articles and review articles published in English were considered for the review. In this review, we describe the clinical implications and management of patients with acromegaly, consisting of scientific improvements underlying the developing understanding of pathogenesis and diagnosis, associated comorbidities and mortality rate with the disease, and major improvements in the treatment of the disease, along with novel strategies including quality of life and patient-reported outcomes.